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Fruits etc..& TKI's

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#1 jenz


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Posted 06 September 2011 - 07:48 AM

I am aware of a few things to avoid while on a TKI medication.

1. Grapefruit - juice, fruit, extract should all be avoided

2. Calcium - can be taken just not at the same time as your TKI dose.

I just realized that for the last week I have been eating Navel Oranges.  Are we suppose to avoid ALL citrus fruits or just Grapefruit? I went back and looked at my Tasigna pamplet and it only calls out Grapefruit.

Any other food/fruits I should avoid?

#2 LivingWellWithCML


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Posted 06 September 2011 - 08:28 AM

I have heard that pomegranate should be avoided ... but I don't think it's formally documented.  But I'm quite sure that oranges are not an issue.

With that said, all that grapefruit does is slow down the processing of a TKI in the liver, which might increase the concentration of the drug in your bloodstream (and hence, the side effects).

I'm still wondering if I could reduce my Gleevec daily dose and just consume an appropriate amount of grapefruit to compensate!!

Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg

#3 sdl722


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Posted 06 September 2011 - 09:28 AM

Hi Jenz,

My onc has told me to not have any grapefruit, Seville oranges (blood red oranges), star fruit or pomegranate and anything containing the juices of these fruits (extracts, etc.).  I eat navel oranges all the time (and drink a daily glas of OJ) and was told by my onc team that those are fine.


#4 cousineg


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Posted 06 September 2011 - 09:37 AM

See Food and drug interactions

#5 janne



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Posted 06 September 2011 - 06:35 PM

Actually, there was someone on this board who did eat the forbidden fruit just to elevate the drug levels in his bloodstream. (I think it was a "he".) Does anyone remember that post ? I do not believe he had lowered his drug dosage though. 

Dx'd: 8/2008. Started Gleevec 400 mg 11/08. 

Drug break 2011.

Started Tasigna 4/11 450 mg.

Reduction to 300 mg Tasigna 1/2012.

PCRU 9/2012.

12/2012 Detectable.

PCRU 4/2013 through 3/2015. (Reduced to 150 mg 7/2014)

12/2015  ? slightly detectable at probably less than 0.01% per Mayo Clinic.

4/2016 PCRU. Still at 150 mg Tasigna.


CESSATION: stopped treatment 7/20/2017. 

9/6/2017:  barely detectable at 0.01%. 

12/11/2017: PCR at 0.09% (did not do the monthly PCR testing.) 

12/18/2017: Inevitable call from Onc. Started back on Tasigna at 150 mg. (Considering Sprycel low dose.) 

#6 GerryL


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Posted 06 September 2011 - 07:29 PM

Hi jenz,

It is really about whether it is an inducer or inhibitor to liver enzyme - grapefruit is an inhibitor.

Gleevec is metabolized (broken down) by the liver. The enzyme most responsible for this is called CYP3A4 (one part of the "cytochrome P450" family of liver enzymes). The next most important enzyme for metabolizing Gleevec is CYP2D6.

Drugs that inhibit the activity/production of these two enzymes (but especially CYP3A4) slow down the metabolism of Gleevec. This results in a higher concentration of Gleevec in the blood. This could result in more side effects from Gleevec; similar to taking a higher dose of Gleevec. This would be more of a concern for patients already taking a high dose of Gleevec especially if they were already having significant Gleevec side effects.

For patients on a lower dose of Gleevec that were having few or no side effects, then taking a drug that might "inhibit" CYP3A4 or CYP2D6 would probably have less effects, and perhaps not even be noticed.

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